Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2021

Open Access 01-12-2021 | Research

Educational attainment in patients with congenital heart disease: a comprehensive systematic review and meta-analysis

Authors: Lucia Cocomello, Arnaldo Dimagli, Giovanni Biglino, Rosie Cornish, Massimo Caputo, Deborah A. Lawlor

Published in: BMC Cardiovascular Disorders | Issue 1/2021

Login to get access

Abstract

Background

Our aim was to comprehensively review published evidence on the association between having a congenital heart disease (CHD) compared with not, on educational attainment (i.e. not obtaining a university degree, completing secondary education, or completing any vocational training vs. obtaining/completing) in adults.

Method

Studies were eligible if they reported the rate, odds, or proportion of level of educational attainment in adults by whether or not they had a CHD.

Result

Out of 1537 articles screened, we identified 11 (N = 104,585 participants, 10,487 with CHD), 10 (N = 167,470 participants, 11,820 with CHD), and 8 (N = 150,813 participants, 9817 with CHD) studies reporting information on university education, secondary education, and vocational training, respectively in both CHD and non-CHD participants. Compared to their non-CHD peers, CHD patients were more likely not to obtain a university degree (OR = 1.38, 95% CI [1.16, 1.65]), complete secondary education (OR = 1.33, 95% CI [1.09, 1.61]) or vocational training (OR = 1.11, 95% CI [0.98, 1.26]). For all three outcomes there was evidence of between study heterogeneity, with geographical area contributing to this heterogeneity.

Conclusion

This systematic review identified all available published data on educational attainment in CHD patients. Despite broad inclusion criteria we identified relatively few studies that included a comparison group from the same population, and amongst those that did, few adjusted for key confounders. Pooled analyses suggest evidence of lower levels of educational attainment in patients with CHD when compared to non-CHD peers. The extent to which this may be explained by confounding factors, such as parental education, or mediated by treatments is not possible to discern from the current research literature.
Appendix
Available only for authorised users
Literature
1.
Bernier PLSA, Samoukovic G, Tchervenkov CI. The challenge of congenital heart disease worldwide: epidemiologic and demographic facts. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2010;13:26–34.PubMedCrossRef
2.
Gilboa SMSJ, Nembhard WN, Fixler DE, Correa A. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. Circulation. 2010;122:2254–63.PubMedPubMedCentralCrossRef
3.
Marelli AJMA, Ionescu-Ittu R, Rahme E, Pilote L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation. 2007;115:163–72.PubMedCrossRef
4.
5.
Ladouceur M, Iserin L, Cohen S, Legendre A, Boudjemline Y, Bonnet D. Key issues of daily life in adults with congenital heart disease. Arch Cardiovasc Dis. 2013;106(6–7):404–12.PubMedCrossRef
6.
Hummer RA, Hernandez EM. The effect of educational attainment on adult mortality in the United States. Popul Bull. 2013;68(1):1–16.PubMedPubMedCentral
7.
Davies NM, Dickson M, Davey Smith G, van den Berg GJ, Windmeijer F. The causal effects of education on health outcomes in the UK Biobank. Nat Hum Behav. 2018;2(2):117–25.PubMedPubMedCentralCrossRef
8.
Carter AR, Gill D, Davies NM, Taylor AE, Tillmann T, Vaucher J, et al. Understanding the consequences of education inequality on cardiovascular disease: Mendelian randomisation study. BMJ. 2019;365:11855.
9.
Gerstle M, Beebe DW, Drotar D, Cassedy A, Marino BS. Executive functioning and school performance among pediatric survivors of complex congenital heart disease. J Pediatr. 2016;173:154–9.PubMedPubMedCentralCrossRef
10.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.PubMedCrossRef
11.
Pearce N, Lawlor DA. Causal inference-so much more than statistics. Int J Epidemiol. 2016;45(6):1895–903.PubMedCrossRef
12.
Taylor K, Elhakeem A, Nader JLT, Yang T, Isaevska E, Richiardi L, et al. The effect of maternal pre-/early-pregnancy BMI and pregnancy smoking and alcohol on congenital heart diseases: a parental negative control study. medRxiv. 2020;6:66.
13.
14.
Morgan RL, Thayer KA, Santesso N, Holloway AC, Blain R, Eftim SE, et al. A risk of bias instrument for non-randomized studies of exposures: a users’ guide to its application in the context of GRADE. Environ Int. 2019;122:168–84.PubMedCrossRef
15.
16.
Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ. 2011;342:549.CrossRef
17.
18.
19.
20.
21.
Kokkonen J, Paavilainen T. Social adaptation of young adults with congenital heart disease. Int J Cardiol. 1992;36(1):23–9.PubMedCrossRef
22.
Olsen M, Hjortdal VE, Mortensen LH, Christensen TD, Sørensen HT, Pedersen L. Educational achievement among long-term survivors of congenital heart defects: a Danish population-based follow-up study. Cardiol Young. 2011;21(2):197–203.PubMedCrossRef
23.
Ozcan EE, Alaattin K. Impact of congenital heart disease on higher education. Circulation. 2010;122(2):e207.
24.
Zomer AC, Vaartjes I, Uiterwaal CS, van der Velde ET, Sieswerda GJ, Wajon EM, et al. Social burden and lifestyle in adults with congenital heart disease. Am J Cardiol. 2012;109(11):1657–63.PubMedCrossRef
25.
Maryanne Caruana VG. Congenital heart disease has no negative impact on educational achievements and employment among maltese adult patients under clinical follow-up. Int Cardiovasc Forum J. 2016;6:8.
26.
Udholm S, Nyboe C, Dantoft TM, Jørgensen T, Rask CU, Hjortdal VE. Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels. Congenit Heart Dis. 2019;14(5):803–10.PubMedCrossRef
27.
Schaefer CJ, Hoop R, Schürch-Reith S, Stambach D, Kretschmar O, Bauersfeld U, et al. Academic achievement and satisfaction in adolescents with CHD. Cardiol Young. 2016;26(2):257–62.PubMedCrossRef
28.
Nieminen H, Sairanen H, Tikanoja T, Leskinen M, Ekblad H, Galambosi P, et al. Long-term results of pediatric cardiac surgery in Finland: education, employment, marital status, and parenthood. Pediatrics. 2003;112(6 Pt 1):1345–50.PubMedCrossRef
29.
Bygstad E, Pedersen LC, Pedersen TA, Hjortdal VE. Tetralogy of Fallot in men: quality of life, family, education, and employment. Cardiol Young. 2012;22(4):417–23.PubMedCrossRef
30.
Otterstad JE, Tjore I, Sundby P. Social function of adults with isolated ventricular septal defects. Possible negative effects of surgical repair? Scand J Soc Med. 1986;14(1):15–23.PubMedCrossRef
31.
Lillehei CW, Varco RL, Cohen M, Warden HE, Gott VL, DeWall RA, et al. The first open heart corrections of tetralogy of Fallot. A 26–31 year follow-up of 106 patients. Ann Surg. 1986;204(4):490–502.PubMedPubMedCentralCrossRef
32.
Pfitzer C, Helm PC, Rosenthal LM, Walker C, Ferentzi H, Bauer UMM, et al. Educational level and employment status in adults with congenital heart disease. Cardiol Young. 2018;28(1):32–8.PubMedCrossRef
33.
Moller JH, Patton C, Varco RL, Lillehei CW. Late results (30 to 35 years) after operative closure of isolated ventricular septal defect from 1954 to 1960. Am J Cardiol. 1991;68(15):1491–7.PubMedCrossRef
34.
Karsenty C, Hascoet S, Blot-Souletie N, Galinier M, Maury P, Mondoly P, et al. The medical past of adults with complex congenital heart disease impacts their social development and professional activity. Arch Cardiovasc Dis. 2013;106(8–9):469–70.CrossRef
35.
Simko LC, McGinnis KA. Quality of life experienced by adults with congenital heart disease. AACN Clin Issues. 2003;14(1):42–53.PubMedCrossRef
36.
Rose M, Köhler K, Köhler F, Sawitzky B, Fliege H, Klapp BF. Determinants of the quality of life of patients with congenital heart disease. Qual Life Res. 2005;14(1):35–43.PubMedCrossRef
37.
Eslami B, Sundin O, Macassa G, Khankeh HR, Soares JJ. Anxiety, depressive and somatic symptoms in adults with congenital heart disease. J Psychosom Res. 2013;74(1):49–56.PubMedCrossRef
38.
Rometsch S, Greutmann M, Latal B, Bernaschina I, Knirsch W, Schaefer C, et al. Predictors of quality of life in young adults with congenital heart disease. Eur Heart J Qual Care Clin Outcomes. 2019;5(2):161–8.PubMedCrossRef
39.
Opić P, Roos-Hesselink JW, Cuypers JA, Witsenburg M, van den Bosch A, van Domburg RT, et al. Psychosocial functioning of adults with congenital heart disease: outcomes of a 30–43 year longitudinal follow-up. Clin Res Cardiol. 2015;104(5):388–400.PubMedCrossRef
40.
Brandhagen DJ, Feldt RH, Williams DE. Long-term psychologic implications of congenital heart disease: a 25-year follow-up. Mayo Clin Proc. 1991;66(5):474–9.PubMedCrossRef
41.
Kovacs AH, Saidi AS, Kuhl EA, Sears SF, Silversides C, Harrison JL, et al. Depression and anxiety in adult congenital heart disease: predictors and prevalence. Int J Cardiol. 2009;137(2):158–64.PubMedCrossRef
42.
Ternestedt BM, Wall K, Oddsson H, Riesenfeld T, Groth I, Schollin J. Quality of life 20 and 30 years after surgery in patients operated on for tetralogy of Fallot and for atrial septal defect. Pediatr Cardiol. 2001;22(2):128–32.PubMedCrossRef
43.
Moons P, Van Deyk K, Marquet K, De Bleser L, De Geest S, Budts W. Profile of adults with congenital heart disease having a good, moderate, or poor quality of life: a cluster analytic study. Eur J Cardiovasc Nurs. 2009;8(2):151–7.PubMedCrossRef
44.
Eren NK, Kırdök AH, Kılıçaslan B, Kocabaş U, Düzel B, Berilgen R, et al. Quality of life of patients with atrial septal defect following percutaneous closure. Cardiol Young. 2015;25(1):42–6.PubMedCrossRef
45.
Riley JP, Habibi H, Banya W, Gatzoulis MA, Lau-Walker M, Cowie MR. Education and support needs of the older adult with congenital heart disease. J Adv Nurs. 2012;68(5):1050–60.PubMedCrossRef
46.
Bang JS, Jo S, Kim GB, Kwon BS, Bae EJ, Noh CI, et al. The mental health and quality of life of adult patients with congenital heart disease. Int J Cardiol. 2013;170(1):49–53.PubMedCrossRef
47.
Pike NA, Evangelista LS, Doering LV, Eastwood JA, Lewis AB, Child JS. Quality of life, health status, and depression: comparison between adolescents and adults after the Fontan procedure with healthy counterparts. J Cardiovasc Nurs. 2012;27(6):539–46.PubMedPubMedCentralCrossRef
48.
Chen CA, Liao SC, Wang JK, Chang CI, Chiu IS, Chen YS, et al. Quality of life in adults with congenital heart disease: biopsychosocial determinants and sex-related differences. Heart. 2011;97(1):38–43.PubMedCrossRef
49.
Tumin D, Chou H, Hayes D, Tobias JD, Galantowicz M, McConnell PI. Employment after heart transplantation among adults with congenital heart disease. Congenit Heart Dis. 2017;12(6):794–9.PubMedCrossRef
50.
Aherrera JAM, Abrahan LL, Racaza GZ, Train CQ, Jara RD. Depression and anxiety in adults with congenital heart disease using the validated filipino version of the hospital anxiety and depression score (HADS-P). Phillip J Intern Med. 2016;54(1):66.
51.
O’Donovan CE, Painter L, Lowe B, Robinson H, Broadbent E. The impact of illness perceptions and disease severity on quality of life in congenital heart disease. Cardiol Young. 2016;26(1):100–9.PubMedCrossRef
52.
Gleason LP, Deng LX, Khan AM, Drajpuch D, Fuller S, Ludmir J, et al. Psychological distress in adults with congenital heart disease: focus beyond depression. Cardiol Young. 2019;29(2):185–9.PubMedCrossRef
53.
Schiele SE, Emery CF, Jackson JL. The role of illness uncertainty in the relationship between disease knowledge and patient-reported outcomes among adolescents and adults with congenital heart disease. Heart Lung. 2019;48(4):325–30.PubMedCrossRef
54.
Fedchenko M, Mandalenakis Z, Dellborg H, Hultsberg-Olsson G, Bjork A, Eriksson P, et al. Cardiovascular risk factors in adults with coarctation of the aorta. Congenit Heart Dis. 2019;14(4):549–58.PubMedCrossRef
55.
Sluman MA, Apers S, Sluiter JK, Nieuwenhuijsen K, Moons P, Luyckx K, et al. Education as important predictor for successful employment in adults with congenital heart disease worldwide. Congenit Heart Dis. 2019;14(3):362–71.PubMedPubMedCentralCrossRef
56.
Enomoto J, Mizuno Y, Okajima Y, Kawasoe Y, Morishima H, Tateno S. Employment status and contributing factors among adults with congenital heart disease in Japan. Pediatr Int. 2020;62(3):390–8.PubMedCrossRef
57.
Madsen NL, Marino BS, Woo JG, Olsen M. Comparison of economic self-sufficiency and educational attainment in adults with congenital heart disease versus siblings without heart disease and to general population. Am J Cardiol. 2020;135:135–42.PubMedCrossRef
58.
Martinez-Quintana E, Girolimetti A, Jimenez-Rodriguez S, Fraguela-Medina C, Rodriguez-Gonzalez F, Tugores A. Prevalence and predictors of psychological distress in congenital heart disease patients. J Clin Psychol. 2020;76(9):1705–18.PubMedCrossRef
59.
Steiner JM, Dhami A, Brown CE, Stout KK, Curtis JR, Engelberg RA, et al. Barriers and facilitators of palliative care and advance care planning in adults with congenital heart disease. Am J Cardiol. 2020;135:128–34.PubMedPubMedCentralCrossRef
60.
Lopez Barreda R, Guerrero A, de la Cuadra JC, Scotoni M, Salas W, Baraona F, et al. Poverty, quality of life and psychological wellbeing in adults with congenital heart disease in Chile. PLoS ONE. 2020;15(10):e0240383.PubMedPubMedCentralCrossRef
61.
Soufi A, Gouton M, Metton O, Mitchell J, Bernard YF, Bozio A, et al. Quality of life of adult Fontan patients. Cardiol Young. 2021;31(1):97–104.PubMedCrossRef
62.
Connor B, Osborne W, Peir G, Smith M, John A. Factors associated with increased exercise in adults with congenital heart disease. Am J Cardiol. 2019;124(6):947–51.PubMedCrossRef
63.
Riehle-Colarusso T, Autry A, Razzaghi H, Boyle CA, Mahle WT, Van Naarden BK, et al. Congenital heart defects and receipt of special education services. Pediatrics. 2015;136(3):496–504.PubMedCrossRef
64.
Gaetano D, Gargiulo PPB, Careddu L, Egidy-Assenza G, Angeli E, Calcaterra G. What have we learnt 50 years after the first Fontan procedure? J Cardiovasc Med Hagerstown. 2020;21(5):349–58.CrossRef
65.
Stegeman R, Lamur KD, van den Hoogen A, Breur J, Groenendaal F, Jansen NJG, et al. Neuroprotective drugs in infants with severe congenital heart disease: a systematic review. Front Neurol. 2018;9:521.PubMedPubMedCentralCrossRef
66.
Grech V, Gatt M. Syndromes and malformations associated with congenital heart disease in a population-based study. Int J Cardiol. 1999;68(2):151–6.PubMedCrossRef
67.
Shillingford AJ, Glanzman MM, Ittenbach RF, Clancy RR, Gaynor JW, Wernovsky G. Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease. Pediatrics. 2008;121(4):e759–67.PubMedCrossRef
68.
Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ. Long-term school outcomes for children with attention-deficit/hyperactivity disorder: a population-based perspective. J Dev Behav Pediatr. 2007;28(4):265–73.PubMedCrossRef
69.
Joshi M, Tulloh RM. Respiratory virus prophylaxis in congenital heart disease. Future Cardiol. 2018;14(5):417–25.PubMedCrossRef
70.
Cahill TJ, Jewell PD, Denne L, Franklin RC, Frigiola A, Orchard E, et al. Contemporary epidemiology of infective endocarditis in patients with congenital heart disease: a UK prospective study. Am Heart J. 2019;215:70–7.PubMedCrossRef
71.
Giuseppe CAC, Guccione P, Di Salvo G, Bassareo PP. Infective endocarditis triangle. Is it the time to revisit infective endocarditis susceptibility and indications for its antibiotic prophylaxis. Eur J Prev Cardiol. 2019;26(16):1771–4.CrossRef
72.
Lawlor DA, Tilling K, Davey SG. Triangulation in aetiological epidemiology. Int J Epidemiol. 2016;45(6):1866–86.PubMed
73.
74.
Metadata
Title
Educational attainment in patients with congenital heart disease: a comprehensive systematic review and meta-analysis
Authors
Lucia Cocomello
Arnaldo Dimagli
Giovanni Biglino
Rosie Cornish
Massimo Caputo
Deborah A. Lawlor
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-021-02349-z

Other articles of this Issue 1/2021

BMC Cardiovascular Disorders 1/2021 Go to the issue

Research

Inverse correlation between serum irisin and cardiovascular risk factors among Chinese overweight/obese population

Research

Cycle length of nonsustanied ventricular tachycardias among ICD patients: implications on subsequent appropriate therapies

Research

Identification of biomarkers associated with metabolic cardiovascular disease using mRNA-SNP-miRNA regulatory network analysis

Research

Impact of autoantibodies against the M2-muscarinic acetylcholine receptor on clinical outcomes in peripartum cardiomyopathy patients with standard treatment

Case report

Coronary artery perforation secondary to lifesaving pericardiocentesis for cardiac tamponade: a case report

Research article

Midterm follow up of transcatheter closure of coronary artery fistula with Nit-Occlud® patent ductus arteriosus coil

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits